Objective To understand the clinical features of peripheral cholangiocarcinoma (PC) developed against the background of hepatolithiasis. Methods Between 1995 and 2002, a total of 11 PC patients with definite history of hepatolithiasis were treated surgically in our hospital. The diagnosis, treatment and prognosis of this clinical entity were retrospectively analyzed. Results Peripheral cholangiocarcinoma occurred in 5 1% of patients with hepatolithiasis in this group and the tumor was located in the left lobe in 7 (64 7%) cases. All patients underwent laparotomy, with diagnosis established preoperatively in 3 (27 2%) cases and intraoperative diagnosis was missed in 2 (18 1%) cases. Radical resections were performed in only 3 (27 2%) cases. The overall operative morbidity and mortality were 72 7% and 9 1% respectively . Infection was the main postoperative complication. The postoperative 1 and 2 year survival rate was 33 3% and 11 1% respectively. Conclusions Cholangiocarcinoma may develope in patients with a history of hepatolithiasis. The prognosis of PC is still poor because of the difficulty to achieve early diagnosis and radical resection.

Objective To investigate the discharge outcome and its clinical influential factors of acute poisoning in children, and to provide the clinical references for prevention. Methods Questionaire about acute poisoning in children made by the research group,the hospitalized children and the influential factors were analyzed according to the outcome. Results Among 168 cases of acute poisoning hospitalized children,the curative rate was 80.95%, 16 cases(9.52%) were improved,6 cases (3.57%)were quitted,1.20% was ' not curative' and 4. 76% died. The factors including age,treatment time, route of entry, varieties of poison, medical examination of admission were statistically associated with the discharge outcome.Conclusion The outcome can be improved through an intensive nurse of the children under the age of three and early treatment. The cases who were not poisoned by the invasion of gastrointestinal tract,paraquat poisoning,and those with abnormalities of breathing, pupilla, awareness in medical examination of admission would have poor discharge outcomes, and should be monitored closely and treated timely.

OBJECTIVE: To develop an ultra-high performance liquid chromatography-mass spectrometry method for the determination of glimepiride and its metabolites (M1) simultaneously in human plasma.

Objective To evaluate the treatment modalities for local recurrent periampullary carcinoma. Methods From January 1997 to May 2007, 23 patients with local recurrent periampullary carcinoma underwent different therapy. The recurrent tumor was resected through laparotomy in 3 cases and the unresectable tumors were treated with radiofrequency ablation(RFA) in 5 patients. In 10 patients and 5 patients respectively high intensity focused ultrasound ( HIFU ) and regional chemotherapy ( RC ) were performed. Results The resection rate for local recurrent periampullary carcinoma was 13% in this group, 2 patients have survived for 10 months and 13 months respectively after reoperation while one patient achieved tumor-free survival for six months so far. The symptoms were alleviated to some extent in 20 patients treated with RFA, HIFU or RC. Conclusions Resection of local recurrent periampullary carcinoma may benefit a longer survival time, and the improvement of the quality of life. RFA, HIFU and RC are the alternative modalities for patients with unresectable tumors.

Diabetes Mellitus, Type 2 ; complications ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myelinolysis, Central Pontine ; complications ; diagnosis ; Prognosis

Cholesteatoma ; diagnosis ; pathology ; Humans ; Petrous Bone ; pathology

Background and purpose:Methylene tetrahydrofolate reductase (MTHFR) plays an important role in metabolism of folate and DNA methylation. This study aimed to investigate the relationship between methylene tetrahydrofolate reductase (MTHFR) C677T polymorphism and chemotherapy side effects in advanced non-small cell lung cancer (NSCLC) patients. Methods:A total of 100 patients with advanced NSCLC conifrmed by pathology were included into this study in Zhejiang Cancer Hospital from Jun. 2007 to May. 2009. All patients received the combined chemotherapy of platinum drug and gemcitabine. MTHFR genotypes were determined by allele-specific-PCR technology. Results:In the 100 cases, genotype frequency of MTHFR C677T T/T, T/C and C/C were 20%, 44%and 36%, respectively. Compared with patients of T/T and T/C genotype, patients of C/C genotype were correlated with decreased rate of thrombocytopenia to chemotherapy (P=0.039). No signiifcant differences were observed concerning gastrointestinal toxicity. Conclusion:MTHFR C677T gene polymorphism can be used to predict the adverse reactions to platinum-based chemotherapy in patients with advanced NSCLC.

Objective To investigate whether there are correlation among changes of Treg/Th17 ratio with virological response and serological re?sponse in patients with hepatitis B e antigen(HBeAg)?positive chronic hepatitis B(CHB)after receiving entecavir. Methods 27 patients with HBeAg?positive CHB were enrolled for the study. Peripheral blood Treg cell frequency and Th17 cell frequency,HBV DNA,alanine aminotransfer?ase levels,hepatitis B virus marker were detected before and after entecavir treatment at 4,12,24,36,and 48 weeks. Peripheral blood Treg cell frequency and Th17 cell frequency of 20 healthy volunteers were detected as well. Results Treg/Th17 ratio of patients decreased from 4 week and reached the lowest point at 12 weeks. Treg/Th17 ratio(12 weeks)of the patients who got the early virological response and HBeAg disappeared was lower than others,and the difference was statistical significant. Conclusion Treg/Th17 ratio changes in HBeAg?positive CHB patients receiv?ing entecavir antiviral treatment. Treg/Th17 ratio(12 weeks)showed significant correlation with early virological response and HBeAg disappear?ance. The changes of Treg/Th17 ratio may provide a reference of curative effect.

Objective: To observe the clinical efficacy of moxibustion therapy plus Liu's pediatric massage (tuina) for children with recurrent respiratory tract infections due to qi deficiency of spleen and lung. Methods: A total of 60 children who met the inclusion criteria were divided into an observation group and a control group according to the visiting sequence, with 30 cases in each group. Children in the observation group were treated with moxibustion therapy plus Liu's pediatric massage, and those in the control group were treated with Liu's pediatric massage alone. The incidence of respiratory tract infections and traditional Chinese medicine (TCM) symptoms score were observed and recorded in both groups before and after treatment. And the clinical efficacy was compared between the two groups. Results: The total effective rate of the observation group was 93.3％, and that of the control group was 83.3％. The difference between the two groups was statistically significant (P<0.05). After treatment, the TCM symptoms score and total times of infections in both groups were all statistically different from those before treatment (all P<0.05). The differences in TCM symptoms score and infection frequency before and after treatment in the observation group were statistically different from those in the control group (both P<0.05). Conclusion: Moxibustion therapy plus Liu's pediatric massage has a better effect in improving the clinical symptoms and reducing the frequency of respiratory tract infections for children with recurrent respiratory tract infections due to qi deficiency of spleen and lung than the pediatric massage alone.

Objective To observe the efficacy,toxic side effects, survival time and quality of life (QOL) of vinorelbine and vinorelbine plus carboplatin in elderly patients with stage Ⅲ b/Ⅳ non-small cell lung cancer(NSCLC).Methods Eighty patients aged 65 years or over with stage Ⅲ b/Ⅳ non-small cell lung cancer were randomly divided into two groups.One group was treated with vinorelbine (vinorelbine 25 mg/m2 iv d1,8, repeated every 21 days), the other group was treated with vinorelbine plus carboplatin(vinorelbine 25 mg/m2 iv at day 1 and 8 and earboplatin AUC5 iv at day 1, repeated every 21 days).Results The response rate(RR), median survival time(MST) and 1-year survival rate were 35.0%, 9.0 months and 35.0% in vinorelbine group and were 42.5%, 10.0 months and 37.5% in vinorelbine plus carboplatin group respectively.There was no significant difference between two groups(χ2 =0.296,P=0.586).The incidences of Ⅲ-Ⅳ degree granulocytopenia (χ2 =7.168,P=0.014), Ⅲ-Ⅳ degree thrombocytopenia (χ2 = 5.165,P=0.048)and Ⅲ-Ⅳ degree nausea and vomiting (χ2 =6.275, P =0.025) were significantly higher in the combined chemotherapy group than in the vinorelbine treatment group.The scores of lung cancer symptom scale (LCSS) of appetite loss(χ2 =2.600,P=0.011), fatigue(χ2 =3.169,P=0.002) and pain(χ2 =2.257,P=0.027) were more higher in the vinorelbine treatment group than in the combined chemotherapy group.Conclusions Vinorelbine regimen is effective, well tolerated and more favorable for the elderly NSCLC patients.